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Previous exam Qs Flashcards

1
Q

2 blood tests for alcohol dependence

A

MCV - macrocytic anaemia (due to low B12 and folate)

GGT

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2
Q

What investigation should be undertaken before treating opiate addiction?

A

ECG - before giving methadone as it can prolong QT and cause sudden cardiac death

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3
Q

2 treatments for detox of opiates

A

methadone

buprenorphine

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4
Q

3 features of alcoholic dependence syndrome

A 
Increased tolerance
Physiological withdrawal symptoms
Difficulty controlling quantity
Cravings
Loss of control
Preoccupation with drug taking behaviour
Continuation despite adverse effects
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5
Q

What is depersonalisation

A

the feeling of not feeling real, feeling detached and not capable to feel emotion

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6
Q

What is derealisation

A

altered perception that the external world is unreal

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7
Q

What is it called when you feel like you are going to die

A

Sensation of impending doom

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8
Q

Endocrine causes of panic attack

A

Phaeochromocytoma (tumour in the adrenal medulla –>increase in adrenaline)
Cushings disease (tumour in the pituitary –> increase in ACTH and cortisol)
Carcinoid syndrome (neuroendocrine tumour leads to high serotonin)
Hyperthyroidism

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9
Q

Treatments of panic disorder

A

CBT
Antidepressants
Low intensity talking therapies if mild

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10
Q

3 signs of preterm labour

A 
PROM
open cervical os
contractions
pathological CTG 
pressure in pelvis
vaginal spotting
lower back pain
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11
Q

3 investigations for a placental abruption

A

Blood tests (FBC, clotting, group and save)
Kleihauer test for Rhesus negative
USS
CTG

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12
Q

2 managements for abruption

A

Give steroids
Give anti-D of rhesus negative
Group and save/cross-match
Active management for 3rd stage of labour (syntocinon, ergometrine etc)
Deliver the baby if >34 weeks or in unstable fetus

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13
Q

Differentials for mass bleeding and pain

A

threatened miscarriage
ruptured/haemorrhaged ovarian cyst
ectopic pregnancy
fibroids

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14
Q

if a woman has a positive Bhcg what is the definitive investigation

A

TVUS - see if there is anything in the uterus

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15
Q

6 symptoms of depression

A 
anhedonia
anergia
low mood
loss of libido
lack in appetite
suicidal ideation 
feelings of helplessness and hopelessness
disturbed sleep
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16
Q

3 cognitive symptoms of depression

A

lack of concentration
forgetfulness
low motivation
difficulty making decisions

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17
Q

Name the screening tool for depression

A

PHQ 9 or HAD

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18
Q

3 management strategies for depression

A 
CBT
computerised CBT
group CBT
interpersonal therapy (IPT)
SSRIs
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19
Q

Define incidence

A

the number of new cases in a given period of time over the total population at risk at the give time

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20
Q

TB XR signs

A 
bihilar lymphadenopathy
ghon focus
non-caseating granuloma
consolidation
pleural effusion
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21
Q

2 investigations for TB

A

3 deep cough sputum samples

XR
CT thorax

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22
Q

4 treatments of TB and a SE for each

A

Rifampicin (orange wee)
Isoniazid (peripheral neuropathy)
Pyrazinamide (hepatitis)
Ethambutol (optic neuritis)

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23
Q

3 GI features and 3 non GI features of Crohns

A

GI features

  • diarrhoea
  • abdo pain
  • mouth sores
  • bloody stool
  • weight loss

Non GI features

  • arthritis
  • erythema nodosum
  • primary sclerosing choleangitis
  • malabsorption (vitamin deficiencies)
  • clubbing
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24
Q

3 features on histology of Crohns

A 
Transmural inflammation
Lymphocytes
Crypt atrophy
Granulomas
Oedema
Skip lesions
Terminal ileum
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25
Staining of TB
Ziehl Neillson test - acid fast bacilli | Lowenstein Jensen test - specific for TB
26
4 SEs to steroids in young girl
``` Acne Difficulty sleeping Weight gain Excess hair Deepened voice Clitoral enlargement ```
27
If there is a cord lesion and vibration and proprioception is spared what column was spared
DCML | dorsal column medial lemnisus
28
If there is a cord lesion and pain and temperature is lost what column was severed
Spinothalamic (lateral)
29
What tract carries the motor neurones
Corticospinal | decussates in the pyramids so that is why you get extrapyramidal signs
30
What plantars do you have an UMN
upgoing (Babinskis)
31
How do you assess mental state
GPCOG MMSE 6CIT AMT
32
Causes of confusion in the elderly
``` D - drugs E - eyes, ears and other sensory impairment L - low O2 state I - ictal state R - retention of urine or stool I - infection U - under hydrated M - metabolic disturbances S - subdural ```
33
2 nursing strategies for confusion
``` quiet room good lighting calandars clocks rehydrate feed ```
34
4 metabolic/endocrine tests for hypoactive sexual desire disorder (HSDD)
``` testosterone low oestrogen hypercholestrolaemia DM prolactin (hyperprolactinoma decreases libido) TFTs (hypothyroidism) ```
35
2 non metabolic/endocrine causes of HSDD
Depression Anxiety Relationship problems
36
2 treatments for HSDD
``` Cabergoline for hyperprolactinaemia Couples therapy Testosterone Flibanserin Sensate focus ```
37
Describe the swiss cheese model
Cheese slices are barriers to error propagation | Holes - failures in the barriers
38
4 principles of clinical negligence
was there a duty of care was there a breech in this duty of care did the patient come to harm was the harm due to the breech
39
RDA for men and women on alcohol
14 units
40
type of anaemia in alcoholism
marcocytic anaemia
41
cause of macrocytic anaemia
B12 and folate deficiency
42
what liver enzyme is elevated in alcoholism
GGT
43
Causes of haematemesis in alcoholism
mallory weiss tear bleeding varices gastritis peptic ulcer
44
alcoholism signs on inspection of abdomen
ascites hepatomegaly splenomegaly spider naevi
45
Treatment of delerium tremens
diazepam, chlorodiazepoxide
46
Enlarged prostate investigations
PSA transrectal US prostatic biopsy
47
How do you assess the extent of cancer spread
CT abdomen and chest Alkaline phosphotase Isotope bone scan Serum calcium
48
3 treatments in prostate cancer
prostate surgery radiotherapy anti-androgen therapy (flutamide) orchidectomy
49
pt with prostate cancer becomes more unwell increase in urinary frequency, thirsty, constipated, less mentally sharp what is causing this
hypercalcaemia
50
immediate treatment for hypercalcaemia
IV fluids
51
how do you treat hypercalcaemia in the long term
bisphosphonates | diuretics
52
Immediate treatment of suspected meningitis at GP
IM Ben Pen
53
Bacterial meningitis on CSF
raised protein decreased glucose increased WCC
54
Childhood vaccinations to prevent meningitis
HiB | Men C
55
Prophylactic treatment of meningitis in close contacts
Rifampicin | Ciprofloxacin
56
Most common malignant neoplasm to affect the breast
adenocarcinoma
57
genes in breast cancer
BRCA 1 and 2 | p53
58
where does breast cancer first metastasise too
axillary lymph nodes
59
what cancers metastasise to the bone
``` bronchus thyroid kidney prostate breast ```
60
What special laboratory tests should be carries out on the biopsy tissue of breast lump
oestrogen receptor status | HER-2 status
61
What systolic murmur is heard all over the precordium and over the carotid arteries and can cause collapse
aortic stenosis
62
What measurement on a CXR would show that the heart is enlarged
cardiothoracic ratio > 0.5
63
what can causes a double cardiac shadow on the right side of the heart
enlarged left atrium
64
Left ventricular hypertrophy signs on ECG
R wave in V5 or V6 of over 25mm S wave in V1 or V2 of over 25 mm Sum of S wave in V1 plus R wave in V6 of over 35mm
65
Other abnormalities on a patient with aortic stenosis and LVH
``` Left bundle branch block T wave inversion in LV chest leads Left axis deviation Left bundle branch block P mitrale (or equivalent) ```
66
2 long-term consequences from LVH
``` sudden death arrhythmias - AF, VT Left heart failure Angina Right heart failure Cerebral Embolus ```
67
How does fluoxetine act
Inhibit the neuronal reuptake of serotonin from synaptic cleft therefore increasing its bioavailability Downregulate the number of 5HT receptors Acts in the prefrontal cortex
68
What is the minimum time for antidepressants to be taken and why?
6 months | To prevent relapse
69
Apart from 5HT receptors what other receptors do TCAs block and what SEs do they cause
Muscarinic receptors - dry mouth, constipation, urinary retention and blurred vision Histamine receptors - sedation Alpha 1 receptors - hypotension
70
What would make you think a patient has had an overdose of paracetamol
``` Tachycardia Dilated pupils Enlarged bladder Hypotensive Unconsious ```
71
What inheritance pattern is Alzheimer's disease and what is the chance of a child getting the condition
Autosomal dominant | 15%
72
What BP med leads to postural HTN
Loop or thiazide diuretics
73
2 activities to reduce postural HTN
sit up slowly and rest before standing | raise and lower arms 5 times before standing
74
In a Parkinsons patient what neurological sites account for tremor, BP and incontinence
Basal ganglia Corpus Striatum Nigrostriatal tract Sympathetic autonomic NS
75
3 infectious disease causes of hepatomegaly
``` Typhoid Glandular fever Toxoplasmosis CMV Hepatitis Malaria Schistosmiasis ```
76
Name an antibiotic that is a DNA gyrase inhibitor
ciprofloxacin
77
Where do serum transaminases come from?
hepatocytes
78
What is the blood test confirms glandular fever
Monospot | EBV IgM
79
What cells proliferate in glandular fever
Epithelial cells | B lymphocytes
80
Why does anaphylaxis lead to hypotension
Hypovolaemic shock | vasodilation causes increase vascular permeability and fluid loss into the vascular space
81
State the class of the immunoglobulin, the name of the cell and the name of the chemical mediator involved in anaphylaxis.
ANAPHYLAXIS IgE Mast cells Histamine
82
Treatment of anaphylaxis and route
IM adrenaline
83
Hyperkalaemia
Absent p waves Tall tented T waves Wide QRS complex Prolonged PR interval
84
What drug treatment is given to immediately decrease high serum potassium?
Calcium gluconate
85
What drugs do you need to administer to this patient to ensure that potassium ions enter cells from the extracellular fluid?
Insulin | Dextrose
86
Agitated patient with hallucinations comes into A&E – treated with 5mg IV Halperidol. After a few minutes develops jerking/rigidity of neck and jaw muscles. What is this reaction called
Acute dystonic reaction - intermittent spasmodic or sustained involuntary contractions of muscles in the face, neck, trunk, pelvis, extremities, and even the larynx after the administration of a neuroleptic drug
87
What is an oculogyric crisis
when the eyes roll backwards into the head
88
Name 2 atypical antipsychotics
``` Olanzapine Arirpiprazole Risperidone Clozapine Quetiapine ```
89
Name 2 drug classes that can cause delerium
``` Benzodiazepines Steroids Opioids Analgesics Antihypertensives Anti-histamines Tricyclic antidepressants ```
90
2 treatmenta after a TIA
Clopidogrel Statin BP medication Warfarin (target INR 2.5)
91
2 medical causes of premature ejaculation
Hyperthyroid Prostate disease Drugs - cocaine and amphetamines
92
3 psychosexual causes of premature ejaculation
``` Anxiety about sexual problems Early learned experience Inexperience Stress Relationship problems Depression ```
93
4 treatments for premature ejaculation
``` Dapoxetine Anitdepressants Topical anaesthetics Couples therapy Stop and start sex Hold breath ```
94
What anaemia would bleeding fibroids cause
Iron deficiency anaemia
95
2 symptoms to assess whether there was any pressure in the pelvic region
Heaviness in the pelvis Discomfort when lying down or bending forward Constipation Increase in urinary frequency
96
3 treatments (1 medical, 1 surgical, 1 radiological) could you offer
``` MEDICAL Tranexamic acid IUD Zoladex (GnRH agonist - shrink fibroid) Mefanamic acid Ulipristal acetate ``` SURGICAL Hysterectomy Myomectomy Resection of fibroids RADIOLOGICAL Endometrial ablation Uterine artery embolisation
97
What delusion do you get in paranoid schizophrenia
Persecutory delusion
98
What delusion do you get in depressive psychosis
Nihilistic delusion
99
What is it when a patient sees a red light and then realises he is being followed
Delusional perception
100
Why would a delusional perception be relevant to the diagnosis in a patient with psychosis
it is a schneideran first rank symptom of schizophrenia
101
Stiff neck with antipsychotic is a sign of what
acute dystonic reaction (torticollis)
102
How do you treat acute dystonic reaction
Procyclidine IM
103
What is restlessness with antipsychotics called
Akathisia
104
Name what receptor and the 3 pathways antipsychotics work on
post synaptic D2 receptors - mesolimbic/mesocortical - nigrostriatal - tuberohypophyseal
105
What 2 investigations should be done before starting on lithium
TFTs | Kidney function tests
106
A patient on lithium developls constipation, cold peripheries and weight gain what has occured
hypothyroidism
107
What is the difference between bipolar 1 and 2
1 - manic episode lasting longer than a week | 2 - more than one episode of depression only hypomania (mild manic episodes)
108
ICD 10 of bipolar
at least 2 episodes where the patient's mood and activity levels have been significantly disturbed
109
3 features of hypothyroidism
``` weight gain increased appetite dry skin goitre thinning of hair brittle nails bradycardia ```
110
3 neurological signs of lithium toxicity
``` brisk reflexes seizures coma coarse tremor ataxia slurred speech blurred vision ```
111
Why is advisable to deliver a post-term fetus with no signs of labour
intrauterine fetal death
112
2 methods of inducing labour
Oxytocin (syntocinon) Prostaglandins (misoprostol) Amniotomy
113
3 features on a Bishop's score
``` Cervical effacement Cervical dilation Cervical consistency Cervical position Station ```
114
3 reassuring features on a CTG
HR 110-160 No decelerations Good variability > 5sec
115
Patient has already had a beta hCG and an ultrasound - how would you diagnose an ectopic pregnancy
laparoscopy
116
3 treatments for ectopic pregnancy
Methotrexate Salpingostomy Salpingectomy
117
4 risk factors for ectopic pregnancy
``` previous ectopic pregnancy PID Smoking Endometriosis Ashermans IUD Previous surgery Submucosal fibroids IVF ```
118
Incidence of ectopic pregnancy
1%
119
Recurrence rate after one ectopic pregnancy
10%
120
3 features of a febrile seizure than would lead you to undertake further investigations
Focal Lasting longer than > 15minutes More than 1 in 24 hours Incomplete recovery after 1 hour
121
What 3 pathological conditions could be discovered upon neurological examination after a febrile seizure
Brain tumour Encephalitis Meningitis
122
What should parents do if the child had another fit
Recovery position | Buccal midazolam
123
3 investigations of neonatal jaundice
FBC Serum bilirubin Blood film
124
If jaundiced baby comes back in 3 weeks later what signs would lead you to think there was an underlying pathology
pale stool | dark urine
125
What would happen to the biceps, triceps and patellar relexes immediately after hemisection of the spinal cord at t2
Biceps and triceps fine | Patellar - increased
126
When spinal shock wears off what happens to the reflexes and tone below the lesion
hyperreflexia | increased tone
127
Vibration and proprioception are spared what column is spared
DCML | dorsal column medial lemniscus
128
What investigation is done for spinal cord lesion
MRI
129
After a few months would he have extensor or flexor plantars
Extensor - upgoing plantars/Babinskis
130
2 causes of confusion and agitation in a man with prostate cancer and evidence of WCC in urine
Urinary retention UTI Prostatitis Uraemia
131
2 nursing strategies for confused patient
place clock in room quiet room well-lit room place calendar
132
Treatment of delirum
Haloperidol
133
If an elderly patient is deemed to have no capacity what needs to be sorted out
DNACPR | LPA
134
What MDT input is there for discharge planning
``` OT PT Dr Social worker Psychologist ```
135
Name 5 criteria for screening
The condition is important The natural history of the condition is known There is an acceptable test for the condition There is an acceptable treatment for the condition The screening is cost-effective There is an agreed policy on whom to treat There is a recognisable latent phase
136
20 year old homosexual with erectile dysfunction name 4 chronic conditions that may lead to this in someone of his age
``` Anxiety PTSD DM MS foreskin problems hypogonadism antidepressant medication spinal cord injuries ```
137
2 investigations for erectile dysfunction
Testosterone SHBG Prolactin BM
138
2 ways to reduce performance anxiety
Counselling | Education
139
Who do you inform in the case of a never event
Patient Family National reporting and learning service PCT
140
When investigating a Never Event, what is the Personal Approach and what is the System Approach? Which should you use?
Personal approach: Holding 1 person responsible for the event Systems approach: Identifying there are latent errors in the system and that latent + active causes come together to cause error. Systems approach - eliminates blame culture
141
1 psychological and 1 medical treatment for panic disorder
CBT | SSRIs
142
Name 3 ICD10 symptoms for OCD
``` Obsessions Compulsions Interfere with daily life Unsucessfully resisted Unpleasant ```
143
Maximum units for men and women
14
144
He says he went from drinking wine, whisky and Beer to only drinking Wine, what symptom of dependence is this?
Narrowed repertoire
145
Blood tests for alcohol dependence
GGT FBC MCV Carbohydrate deficient transferrin
146
3 signs of Wernickes
Ataxia Confusion Opthalmoplegia
147
Combined screening test for Downs
Nuchal translucency PAPP-A bhCG
148
Quadruple test for Downs
Inhibin A bhCG Oestadiol Alpha Fetoprotein (AFP)
149
4 risks of amniocentesis
``` Miscarriage Infection in amnion Haemorrhage Placental abruption Sensitise for RhD ```
150
What should you give before amiocentesis
Anti-D
151
Apart from Downs name 3 over chromosomal abnormalities you can test for
Edwards - 18 Pataus - 13 Angelman - 15
152
4 features that are suggestive of a malignant lesion
``` Bone pain Enlarged lymph nodes hypercalcaemia Weight loss Irregular mass shape Multi-ocular cyst Ascites ```
153
What 4 blood tests would you do pre-op
FBC - Hb, platelets Group and save Clotting screen Coagulation
154
A lady is found with early stage ovarian cancer what operation would you do?
bilateral salpingo-oophorectomy
155
What intraoperative procedure would you do to determine if it is malignany
biopsy
156
9 months child has acute history, lethargy, malaise, redness in the armpit, groin region and neck. Peeling of the skin has started to occur, capillary refill of 4 seconds. Whats the most likely diagnosis?
Staphylococcal Scaled Skin Syndrome
157
Whats the most likely organism causing SSSS, genus and species
Gram positive cocci | Staphylococcus aureus
158
How does the organism in SSSS cause the skin to peel
Staphylococcus epidermolytic endotoxin damages outer layer of skin
159
Little girl comes in with fluctuating fever, malaise with hepatosplenomegaly and pain in her hip with reduced range of motion, what are the two most likely diagnoses?
ALL | Systemic JIA
160
What blood tests are done in ALL
FBC | Blood film
161
What investigation would you do in a painful joint
US
162
3 treatments for inflammatory diseases like arthritis in children
NSAIDs Steroid injections Infliximab Corticosteroids
163
Blood results of hyperthyroidism
low TSH high T3 and T4 Autoantibodies
164
Treatment for hyperthyroidism
Carbimazole Radioactive iodine Thyroidectomy Beta blocker for adrenergic symptoms (sweating, tachycardia)
165
What is a thyroid storm
BP, temperature and HR surge to dangerously high levels
166
What is the pathophysiology of Parkinsons disease
Reduction in the dopaminergic neurones in the substantia nigra of basal ganglia
167
2 signs in upper limb found with Parkisons
cog wheel rigidity pill rolling tremor bradykinesia
168
2 medications for Parkinsons disease
Levo-dopa | Bromocriptine
169
2 drugs that worsen Parkinsons symptoms
Typical antipsychotics Antiemetics Both block D2 receptors
170
Normal pressure hydrocephalus triad
wet wobbly and weird Incontinence Ataxia Dementia
171
Woman with anorgasmia - 8 endocrine blood tests
``` TFTs Fasting glucose SHBG Testosterone GnRH Progesterone Prolactin Cortisol FSH/LH oestradiol ```
172
What are the 4 approaches to couples therapy
Cognitive-behavioural Integrated Systemic Psychodynamic
173
What is need according to NICE
the ability to benefit from an intervention
174
Example of what is supplied but not needed or demanded
Vaccinations
175
Example of what is supplied and needed but not demaded
Screening
176
Example of what is needed and demanded but not supplied
Plastic surgery
177
What is the epidemiological health needs assessment
Looks at trends in causes and effects of health needs
178
What is corporate health needs assessment
Stakeholders views on current needs and priorities for future provision
179
What is comparative health needs assessment
the services in the population are compared and contrasted with those provided at a different time, place or to a different population group.
180
2 flaws of comparative health needs assessment
Hard to find a population similar | Expensive
181
4 criteria of negligence
was there a duty of care was there a breech in the duty of care did the patient come to harm was this harm due to the breech
182
What is a person centred approach to error
Unsafe acts are due to mental processes such as forgetfulness, carelessness, inattention, negligence and recklessness
183
What is the systems approach to error
Humans are fallible and error is to be expected
184
Paracetamol overdose blood tests
``` Clotting - INR, PT, APTT FBC - Hb U+Es - creatinine LFTs - AST/ALT Blood gas - increase in bircarbonate and lactate ```
185
Treatment of paracetamol overdose
N-acetylcysteine
186
6 screening investigations for dementia
``` AMT GPCOG MMSE Mini Cog MSQ MoCA MIS ```
187
4 issues to consider in Alzheimers
``` Capacity Care plan Modification at home LPA DNACPR Polypharmacy Memantine ```
188
Diagnosis of preeclampsia
High BP and protein in urine ++
189
Complications in preeclampsia
``` HELLP Pulmonary oedema Renal failure Cerebrovascular haemorrhage Eclampsia ```
190
4 differentials for post-coital bleeding and intermenstural bleeding
``` Cervical cancer Chlamydia PID Cervical ectropion Cervical polyps Vaginitis Fibroids Uterine polyps ```
191
2 investigations for PCB and IMB
``` Triple swab - high vaginal and endocervical Cervical smear HPV testing US Colposcopy ```
192
2 investigations for DVT
D Dimer | US of leg
193
Name 3 anticoagulants and their contraindications
LMH - previous anaphylactic Warfarin - oesophageal varicies Rivaroxiban - significant hepatic impairment
194
Bulky uterus
Fibroids
195
Boggy uterus
Endometriosis
196
Transtheoretical model
``` Pre-contemplation Contemplation Preparation Action Maintenance Relapse ```
197
What can be done to help intention
Positive social influence Bridge the gap Promote self efficacy
198
2 limitations to theory of behaviour
ignores one needs before engaging in a certain action ignores emotions when making a decision relies on self-reporting assumes arritude and subjective norms can be measured
199
ABG shows high pH, low CO2, normal O2 and normal HCO3 and base excess what is the causes
Respiratory alkalosis | Hyperventilation - blowing off lots of CO2
200
3 antenatal factors the increase the risk of infection in a baby
Group B Strep carrier PROM TORCH (toxoplasmosis, rubella, CMV, herpes/HIV)
201
3 components of CSF in bacterial infection
Low glucose High WCC (neutrophils) High protein
202
What is a long term effect of meningitis
Hearing loss
203
Crying infant, apyrexial, petechial rash on neck, immobile left arm
Blood culture FBC CRP Shoulder/elbox XR
204
3 Differentials for collapse
cardiogenic syncope vaso-vagal syncope seizure TIA
205
Features of temporal lobe epilepsy
Deja Vu Automatisms Difficulty speaking and understanding speech
206
What is first line in reducing frequency of epileptic seizures
Carbamazepine
207
What anti-epileptic is contraindicated in absence seizures
Carbamazepine
208
4 things to assess for capacity
Understand Retain Weigh up Communicate
209
4 things to know for discharge planning
Care package OT review PT review Social worker
210
2 treatments for rapid ejaculation
Topical lidocaine STUD 100 | Dapoxetine
211
What is the rule of rescue
We have duty to safe a life where possible
212
What delusion would you see in depressive psychosis
Nihilistic delusions | Cotard delusions
213
What delusions would you see in paranoid schizophrenia
``` persecutory grandiose delusions of reference capgras delusions fregoli delusions ```
214
Pt sees a red car and knows the police are following him what is this called and why is it relevant
Delusional perception | First rank symptom
215
Give antipsychotic and pt develops neck and jaw spasms what is this called
acute dystonia
216
treatment of acute dystonia
Benzotropine IV/IM | Procyclidine
217
Name 3 atypical antipsychotics
``` Risperidone Aripiprazole Olanzapine Quetiapine Clozapine ```
218
What receptors do atypical antipsychotics work on?
Serotonin-dopamine D2 receptor antagonist
219
What test to do in a man that claims he has a heroin addiction and would like help
Urine drug screen
220
What 2 treatments can you give for opiate addiction
Naltrexone Methadone Buprenorphine
221
3 features of dependency
``` increased tolerance craving withdrawal symptoms neglect of responsibilities and other interests difficulty controlling consumption narrowed repertoire ```
222
2 blood tests in alcoholism
MCV GGT carbohydrate-deficient transferrin
223
23 year old woman comes to your fertility clinic planning to have a baby. She has type I diabetes and hypertension. Taking insulin and Ramipril (an ACE inhibitor). Her BP is under control; she has a background of retinopathy and a raised HbA1c at 90mmol/mol. 4 changes to medication
Stop ACE i Increase insulin Begin labetalol/nifedipine Start folic acid supplement
224
List 2 early pregnancy risks and 3 fetal/neonatal complications with uncontrolled diabetes?
``` Polyhydramnios IUGR Miscarriage Still birth Preterm delivery ``` ``` Neonatal hypoglycaemia Macrosomia Shoulder dystocia Fetal RDS SGA Congenital defects ```
225
4 antenatal investigations to check her risk
BP Fasting blood glucose Urinalysis Uterine artery doppler
226
What test is to check for ovulation
Mid-luteal progesterone - day 21
227
What 2 tests check for tubual patency
HSG | HyCoSy
228
Which test is preferred for checking tubal patency and why?
HyCoSy - no radioactive contrast
229
4 other female investigations for infertility
``` TSH FSH/LH STI screen Prolactin Glucose ```
230
What should the couple do in the mean time
``` Have more sex Lose weight Stop smoking Exercise Diet Folic acid ```
231
Apart from seminal analysis what other tests could the male partner have
FSH/LH
232
Name 4 features that would make you think of hyperthyroidism
``` increased appetite low weight diarrhoea neck swelling sweaty tachycardia change in mood thin hair clubbing palmar erythema resting tremor ```
233
Name 4 featuers than wold make you think of menopause
``` hot flushes night sweats vaginal dryness skin and breast atrophy atrophic vaginitis ```
234
Name 4 features that would make you think of anxiety disorder
insomnia feeling of impending doom anxious across all situations hyperventilation
235
4 treatments for anxiety
``` Beta blocker SSRI - paroxetine CBT Counselling Short term benzo ```
236
3 features of acute severe asthma attack in hcildren
``` PEF 33-50% RR >30 HR >125 inability to complete sentences SpO2 <92% ```
237
3 features of life threatening asthma attack
``` Silent chest Cyanosis Poor respiratory effort Hypotension Exhaustion Confusion PEF<33% ```
238
What 2 medications would you give immediately in acute asthma attack
oxygen | nebulised salbutamol
239
low pH, high CO2, borderline/low HCO3- which 2 changes show deterioration.
Respiratory acidosis with mild metabolic compensation | low pH, high CO2
240
Child not responding to nebulisers what drugs could you give IV
IV Hydrocortisone IV Salbutamol only give IV amniophylline if severe asthma
241
6 questions to ask the parens to assess how well his asthma is controlled
``` Wake up breathless Exercise limitations How often does he use his inhaler Inhaler technique Recent hospital admissions for exaccerbations Daytime symptoms Oral steroids ```
242
3 intestinal and 3 extra intestinal signs of IBD
Intestinal - abdominal mass - anal skin tag - strictures - perianal abscess - fistulae Extra intestinal - erythema nodosum - mouth ulcers - arthritis - uveitis - conjunctivitis - clubbing
243
3 histological features of Crohns
``` Crypt abscesses Granulomas Goblet cell depletion Lymphocyte infiltration Skip lesions Transmural inflammation ```
244
4 effect of steroids on 15 yo girl
``` Increase in hair Amennhorea Deepened voice Weight gain Increased risk of osteoporosis, infections, diabetes ```
245
42-year old plumber with Parkinsonism/Parkinsons, troubles with left arm, tremor in left hand at rest. On Metoclopramide, aspirin, statin, amlodipine - What medication is causing his Parkinsonism symptoms
Metoclompramide - D2 receptor antagonist
246
3 cardinal signs of Parkinsonism
Resting temor Bradykinesia Rigidity
247
What part of the brain is affected in Parkinson's
Basal ganglia - substantia Nigra
248
When writing deteriorates in Parkinsons what is it called
micrographia
249
The patient stops the causative medication and his symptoms initially improve. However he presents a year later with worsening Parkinson’s symptoms. He is therefore given a new medication. This makes him sleepy and his wife says he goes gambling, what drug is responsible?
Dopamine agonists - Ropinirole - Cabergoline
250
What non-pharmacological treatments can improve Parkinsonian symptoms
Physiotherapy Occupational therapy Relaxation therapies
251
3 reasons that could predispose to pressure ulcers
``` Immobile Vascular disease Poor nutrition Dehydration Bowel incontinence - local infection ```
252
What 3 actions can be done to stop pressure ulcers and which member of MDT can help
Mobilisation - PT Improve nutrition - dietician Hygeine/regular turns - nurse Treat incontinence - doctor
253
Her hip fracture was the result of reduced bone density. Name 2 treatments which will improve her bone health
Bisphosphonates Vit D Ad-cal
254
Medically fit for discharge, mobilising with a zimmer frame. Name 2 more things you ask about before sending home.
OT assessment of home | Carers
255
Vaginismus - lady having first cervical smear, she’s very anxious about having her first genital examination? What 3 things need to be done before the examination?
Explain procedure Chaperone Full sexual hx Any traumatic sexual experiences
256
Name the 4 main types of psychosocial therapy
Integrative Systemic Psychodynamic Cognitive behavioural
257
What should GP prescribe for vaginismus
Incremental vaginal trainers
258
3 behavioural interventions
Self-exploration Sensate focussed Couple therapy
259
What is beneficiance
To do good - do the operation
260
What is non-maleficence
To do no harm - resuscitation would cause more harm
261
What is never event
A largely preventable event that should not have happened | eg - not gaining consent
262
who should never events be reported too
National Reporting Learning System (NRLS) | Strategic Executive Information System
263
Explain the system approach to error
Human are fallible to mistake so there should be systems in place to stop this from happening
264
Explain the person approach to error
Error is down solely to the personal mental errors - fixation, sloth, bravado, etc
265
16 year old woman brought to GP by father presenting with 6 month history of abdominal fullness on eating, alleviated by vomiting, with reduced food intake. She was unhappy with her weight and felt fat. BMI of 16. You suspect an eating disorder 3 organic causes of symptoms
IBD Coeliac Pregnancy Gastritis
266
3 tests in bulimia
FBC - anaemia ESR (if high ?organica cause of anorexia) Electrolytes - (hypokalemia, hyponatraemia) U+Es - creatinine (breakdown of muscles) Magnesium (magnesium deficiency can cause nausea and vomiting) LFTs hypercholestrolaemia ECG
267
2 features in history that would confirm diagnosis of anorexia
fear of gaining weight 1/2 kg loss of weight per week amenorrhea overvalued idea of being fat
268
4 physical signs of anorexia
``` Anaemia Muscle wasting Lanugo hair Poor teeth Oligomenorrhea Poor circulation Dry skin Thin hair Bradycardia ```
269
Test for Downs < 12 weeks
Combined test: PAPP-A BhCG Nuchal translucency
270
Test for Downs > 14 weeks
``` Quadrupule test: AFP bhCG Oestriol Inhibin A ```
271
4 complications of amniocentesis
``` Rhesus disease Risk of PROM Risk of miscarriage Risk of chorioamniotitis Placental abruption Club foot ```
272
What should a lady undergoing amniocentesis be given before the procedure and why
Anti-D | To prevent rhesus disease
273
Name 3 other chromosomal abnormalities
Edwards - 18 Pataus - 13 Angelmans - 15
274
What is the initial management of a child with decreased consciousness
ABCDE - glucose Oxygen Fluids
275
2 causes of purpuric rash in a child
HSP Meningococcal septicaemia ITP Leukaemia
276
Low pH Low CO2 Low bicarbonate Low BE What is the abnormality in the blood gas and what is the cause of this abnormality
Metabolic Acidosis Sepsis
277
Prophylaxis of meningiococcal sepiticaemia
first line Rifampicin | Ciprofloxacin
278
What is need according to NICE
The ability to benefit from an intervention
279
Define epidemiological health needs assessment
Looking at patterns in the cause and effect of health needs
280
Define corporate health needs assessment
Health needs according to stakeholders
281
Define comparative health needs assessment
Comparing the health needs to a similar population, place or time
282
Sheltered accommodation 45 year old Down syndrome patient is presenting with a 6 month history of agitation, incontinence of urine, attacking other residents, Suspected depressive syndrome 3 features to clarify diagnosis
Anhedonia Anergia Low mood
283
2 other differentials of previous case
Urinary tract infection | Early onset dementia
284
2 further investigations
Urinalysis | AMT
285
Non-pharmacological interventions
CBT Anger management Mindfulness
286
Steps to mental capacity
Understand Retain Weigh up Communicate
287
Key principles to mental capacity
A person is assumed to have capacity until they a deemed not to have capacity All steps must be taken to ensure that the person is able to make a decision for themselves An unwise decision does not mean someone lacks capacity If a decision is made for someone who lacks capacity it must be done in their best interests The decision must be the least restrictive possible
288
What 3 things are required for a DOLS
lack the capacity to consent to their care/treatment arrangements are under continuous supervision and control are not free to leave in a hospital or care home not under the mental health act >18
289
What does DOLS ensure
``` safety of the patient right to appeal best interest arrangements are reviewed regularly someone is appointed to represent you ```
290
How long does a DOLS last
12 months
291
50 year old woman presents with her friend following ?seizure. Her friend reports that she felt confused, and then had twitching of her right eye, before collapsing to the ground shaking. This lasted 3 minutes before she started to regain consciousness. She is still confused. You conclude that what occurred was an epileptic attack. What 3 features from the history support epilepsy as a diagnosis?
Prodromal phase (aura) Tonic-clonic shaking Post ictal confusion
292
2 non blood investigations
EEG ECG CT
293
How long can someone not drive after a seizure
12 months
294
What are the chances of having another seizure after a first seizure
40-50%
295
First line medication or seizure
Carbamazepine
296
28 weeks gestation, following a placental rupture. Then when he was 2 weeks old he suddenly turned gray and non responsive. Apart from NEC, what 2 conditions could cause this presentation?
``` RDS Intraventricular haemorrhage Hypothermia Hypoglycaemia Sepsis ```
297
``` Acidotic Low O2 High CO2 Normal bicarb Normal BE ``` What does the blood gas show?
Respiratory acidosis
298
2 bowel specific complications of NEC
Bowel perforation Stricture Necrosis
299
3 radiological findings of NEC
XR Distended bowel loops Portal venous gas Bowel wall oedema US Intramural gas Bowel wall thickening Free fluid
300
2 immediate non-surgical interventions for NEC
NBM Broad spectrum antibiotics Gastric aspiration
301
SE of B blocker
``` nausea hypotension vomiting headache cold peripheries impotence ```
302
SE to statin
headache GI disturbances muscle aches rhabdomyolysis
303
SE to clopidogrel
GI disturbance Bleeding thrombocytopenia
304
SE lansoprazole
GI disturbances headache low magnesium osteoporosis
305
Two weeks later, he is feeling exhausted on exertion and is trying to remain as fit as he used to be. He presents with 100/80 BP. The cardiology discharge form advised that you titrate bisoprolol to the highest dose. What would you do? And why?
Titrate dose up keep an eye on the blood pressure if consistently low then ask cardiologist Consider switching to verapamil (off-label)
306
What non-pharmacological measure would you advise for him
Dietary measures Smoking Alcohol
307
4 domains of the geriatric assessment and the MDT for each
Medical (doctor) Mental (psychiatrist) Social (social worker) Functional (OT)
308
Patient is breathless, despite being on maximal medication. | What drug type could you give to treat this?
Oxygen
309
What non pharmaceutical intervention could you do?
PT
310
3 things to consider in an advanced care life plan
Advanced decision (DNACPR) Statement of wishes and preferences LPA
311
Woman presents with irregular cycle since a menarche of 12. She has a 32-40 week cycle, that she would like to be more regular. Give two possible causes of irregular cycle
PCOS Hypothyroidism Under or overweight Stress
312
If she had hirsutism and weight gain, what two tests?
SHBG Testosterone LH/FSH US of ovaries
313
What two non hormonal interventions to control dysmenorrhoea and menorrhagia?
Dysmenorrhoea - mefanamic acid | Menorrhagia - tranexamic acid
314
What 3 management options would you advise
``` Lose weight Meformin OCP IUD Depot provera Implanton ```
315
Man presents with failure to ejaculate (2 endocrine, 2 neuro and 2 medicated side effects) 6 causes
High prolactin Low testosterone Diabetes MS SSRIs Beta blocker
316
He has recently left his wife for a new partner, and is happy in this relationship List two psychosocial reasons for his symptoms
Performance anxiety | Inadequate stimulation
317
2 psychosocial interventions
Integrative couple therapy | Systemic couple therapy
318
What are you trying to rule out during a neurological exam after a febrile seizure
Meningitis, Encephalitis | Neck stiffness, photophobia, rash
319
Domains and members in a Comprehensive Geriatric Assessment
Medical - doctor, pharmacist (meds, adv directive) Mental - psychologist (MCA, mood) Social - social worker (carers) Functional - OT, PT (housing, transport)
320
3 investigations for an ectopic
beta hCG US laparaoscopy
321
Risk facotrs for ectopic
``` submucosal fibroids IUD PID chlamydia prev surgery ashermans ```
322
Features on a Bishops score
``` cervical effacement cervical dilatation cervical consistency cervical position station ```
323
Reassuring features on CTG
HR 110-160 variability >5bpm no decelerations
324
generalised seizure medication
sodium valporate
325
focal seizure medication
carbamazepine
326
Investigations for extent of pre-eclampsia
CT - CVH CXR - pulmonary oedema U+E - renal failure fundoscopy - papilloedema in raised ICP
327
What are the 4 factors of the health belief model?
an individual will change if they: - believe they are susceptible to the condition - believe it has serious consequences - believe that taking action will reduce their susceptability - believe that the benefits outweigh the costs
328
What are the 3 components of theory of planned behaviour?
attitude subjective norm perveived behavioural control
329
5 stages of bridging the gap (ToPB)
``` perceived control anticipated regret implementation intentions preparatory actions relevance to self ```
330
Paracetamol overdose bloods
``` Clotting - INR, PT, APTT FBC - Hb U+Es - creatinine LFTs - AST/ALT Blood gas - increase in bicarbonate and lactate ```
331
2 limitations to the theory of planned behaviour
ignores one needs before engaging in a certain action ignores emotions when making a decision relies on self-reporting assumes arritude and subjective norms can be measured
332
Investigations for rapid ejaculation
TFTs (hyperthyroidism) PSA (prostatitis) Medications (SSRIs) Comorbid sexual problems (ED)
333
Treatment for rapid ejaculation
``` STUD 100 Dapoxetine Pelvic floor exercises Couples psychosexual therapy Sensate therapy Stop start technique Masturbating before sex ```
334
Investigation for delayed ejaculation
``` Urinalysis - sperm in retrograde ejaculation Low testosterone Glucose - diabetes PSA - enlarged prostate B12/folate - alcoholism ```
335
Treatment for delayed ejaculation
``` PSGP individual therapy couples therapy kegel exercises vibration and superstimulation ```
336
Causes for ED
``` DM CVD neurological disorders androgen deficiency high prolactin prostate surgery SSRIs antihypertensives age related changes infective sexual stimuli pain veno occlusive disorder ```
337
What is the Luria test
test for frontal lobe pathology
338
Emergency treatment for an aggressive patient
lorazepam
339
Police sections
135 - section at home | 136 - section in public
340
transmission of hepatitis
``` Hep A - poo Hep B - sex and blood Hep C - blood Hep D - have to have Hep B Hep E - food ```
341
Drugs that are contraindicated in pregnancy
``` trimethoprim NSAIDs warfarin benzos ACE-i (in 2nd and 3rd trimester) ```
342
Facial features in Russell Silver syndrome
triangualr shaped face | carp shaped motuh
343
treatment of essential tremor
propanolol
344
coeliac disease histology
crypt hyperplasia villious atrophy increase in T lymphocytes
345
How long do you have to carry antidepressants on for
6 months after remission
346
How do you investigate PROM
speculum
347
When do you notify about nitifiable diseases and how
inform the local health protection team as soon as you get there is a diagnosis DO NOT WAIT FOR LAB RESULTS send a form within 3 days or if urgent case call within 24 hours
348
When is aspirin given prophylactically in preeclampsia
12 weeks
349
What does a NAAT test look for
its a first void urine looking for chalmydia and gonorrhea
350
first line investigation for an overdose on a TCA
ECG - arrhythmias
351
drugs that cause gynaecomastia
``` spironolactone salbutamol steroids TCAs ABX diazepam digoxin CCB metoclopromide ```
352
gram postitive diplococci
strep pneumoniae | enterococcus
353
gram negative diplococci
neiserria | moraxella
354
dolls eye reflex is indicative of whaat
brainstem death
355
treatment of acute alcohol withdrawal
chlordiazepoxide
356
Blood gas in a salt losing crisis
metabolic acidosis hyponatraemia hyperkalaemia
357
Treatment for gestational diabetes
insulin is gold standard | but metformin is safe
358
name of rash in rheumatic fever
erythema marginatum
359
investigation for scarlet fever
antistreptolysin O titre
360
treatment of scarlet fever
penicillin V
361
management of breakthrough bleeding with progesterone implant
COCP on top for 3 months
362
management for nephrotic syndrome
prednisolone fluid restriction and low salt diet IV furosemide + albumin
363
antihypertensive that cuases facial flushing
CCB
364
treatment of transient synovitis
NSAIDs
365
Meconium ileus is associated with what disorder
CF
366
Define panic attacks
spontaneous not situation specific periods of normality (not constant worry like GAD)
367
Types of bias
information bias selection bias publication bias
368
Non-causal associations
bias chance reverse causality confounding
369
Sensitivity
a/a+c
370
Specificity
d/b+d
371
PPV
a/a+b
372
NPV
d/c+d
373
If population increases what happens to sensitivity and PPV
No change to sensitivity or specificity PPV increases NPV decreases
374
Investigations for TIA
Carotid doppler | ECG
375
What would you do on clinical examination on a man with a suspected TIA
check pulse for AF | auscultate the neck for carotid bruits
376
what is attributable risk
absolute risk in one group - absolute risk in the other group
377
what is relative risk
absolute risk in one group divided by absolute risk in the other group
378
incidence
number of new cases over total population at risk at that time
379
Define epidemiological health needs assessment
assess need based on the extent of the problem
380
What is normal pressure hydrocephalus
``` Enlarging of ventricles to compensate for increase in CSF wet wobbly weird incontinence ataxia confusion/dementia ```
381
Treatment for hyperthyroidism
Carbimazole Radioactive iodine Anticholinergics - sweating B-blockers - HTN
382
What would GP tell patient about after diagnosis hyperthyroids
Safety net warning signs Side effects of drugs opthamology referral
383
ICD10 of OCD
failure to resist behaviour thoughts are repetitive and unpleasant originate in the mind (pt aware of this - insight) carrying out the compulsions is not pleasurable in itself
384
Fears in OCD
fear of making a mistake fear of hurting self fear of hurting others
385
When is the quadruple test done
after 14 weeks

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